Elec c section denied? Forced vaginal birth?

[RollneckJumper]

Apologies in advance for the long post.

I'm 35. This is my first pregnancy. I am 33 weeks.

I have Group B Strep and genital herpes. The latter has been the root cause of 15+ years of tortuous anxiety and depression. I can honestly say the diagnosis all those years ago absolutely destroyed me. It crushed my self confidence, and anxiety is now a permanent feature in my life. I've had regular counselling, sexual health counselling, CBT and I was taking citalopram prior to pregnancy. I can't begin to describe how much of a negative impact its had on my life, mainly my mental wellbeing.

I wish to have an elective c section as I am terrified of passing Group B Strep and/or herpes on to my baby. Herpes ruined my self esteem, self worth and self confidence. I am absolutely determined not to let it ruin my child's life.
Yes, I am aware the risk is low.
Yes, I am aware that women can take antiviral meds in the run up to labour, but I can't. They actually act as a trigger for me and can bring on a reoccurance.

I am also aware of the risks involved with a vaginal birth V c section in regards to herpes, Group B Strep and other risks (I've done my research) and I am making an informed choice - I have made my mind up - want an elective c section.

Earlier in my pregnancy, my midwife referred me to a perinatal psychiatrist because of my anxiety around a vaginal birth. The psychiatrist is of the opinion that I should be supported in my request for a elective c section and that a vaginal birth would be detrimental to my mental health.

This morning I saw a doctor from the consultant obstetrician's team. She went over c section risks with me. I pointed out that I had already gone over the risks a month earlier with one of her colleagues and I still hadn't changed my mind.
She contined talking about the risks of a c section and it was clear she was trying to talk me out of my decision. I felt like my anxiety was not taken into consideration at all, and the whole focus of the conversation was her trying to convince me why a vaginal birth would be best. She then went on to say that I would need to see the consultant obstetrician who would make the decision on whether or not to grant me a c section.... this left me in tears, terrified that I may be told "No!". I asked her what would happen if the consultant obstetrician says "no". She said I could see another consultant obstetrician.

But what if that consultant obstetrician also says "no"? Where does that leave me? Do I then have no choice but to give birth vaginally? I thought it was "my body, my choice" ? I wasn't aware an elective c section could actually be refused?

I am now back home in tears at the prospect of being denied an elective c section and forced to give birth vaginally. My anxiety is soaring at the thought of this.

I know NICE guidelines say I should be offered a c section if I want one.. but they are guidelines, not law. Where do I stand?

Does anyone have advice on what I can do?

Also.. polite request.. I have made my mind up regarding my birthing options, please no comments from anyone trying to persuade me otherwise. Thank you

@Mylittlesandwich you have obviously missed the women in the world that 'hope' for a small baby then 🙄

Honestly no I haven't. Anyone I know with a small baby has been pretty apprehensive about it all. I know my mum wished I'd been bigger.

I thought it was "my body, my choice"

No, that's not applicable here. It's not your choice whether a surgeon will operate on you, its theirs. If you wanted a healthy leg cut off you wouldn't expect it to be your body your choice.

Don't listen to those telling you that you will def get a CS, they aren't helping, because there is no def about it. Entire hospitals simply don't do elective CS. Some women don't even get the emergency sections they should get.

@andtheHossyourodeinon

I thought it was "my body, my choice"

No, that's not applicable here. It's not your choice whether a surgeon will operate on you, its theirs. If you wanted a healthy leg cut off you wouldn't expect it to be your body your choice.

Don't listen to those telling you that you will def get a CS, they aren't helping, because there is no def about it. Entire hospitals simply don't do elective CS. Some women don't even get the emergency sections they should get.

This

Most of the hospitals in my area won't do elective/planned c sections.

I ended up having an ELCS privately due to a horrific experience with a vaginal birth with dc1. I was determined to have it done, knew all the guidelines etc, even had a letter from PALS as my treatment during my first labour resulted in the hospital changing practice.

I went into spontaneous labour at 36 weeks with dc1. I was 35 weeks and had met with 3 separate consultants, all who had said they wouldn’t agree to me having an ELCS. I was convinced I was going to go into labour early again and be forced to have a vaginal birth. I was a complete mess and sobbing every night that I wish I knew earlier as I’d have had an abortion rather than go through labour again. Very kindly my in laws offered to pay for me to have it done privately. I had my first meeting, consultant was lovely and kind and said it happened quite a lot, they just refer you to other consultants until your due date when it’s too late. If going private is an option at all OP I’d seriously consider it.

Keep pushing OP. Don’t let them fob you off and if they offer you meetings with consultants weeks in the future ask for them to be as soon as possible. I hope you get something booked.

Please try to stay calm. It is almost certainly the case that the doctor you saw today does not have the authority to agree to an ELCS. I won't make you any promises but if you have the support of the psychiatrist then your odds are good, even in those trusts which don't conduct maternal requests CS.

I had an ELCS agreed for DC2 due to previous birth injuries, and still got my section when I went into spontaneous labour. Good luck.

Can I ask @RollneckJumper did you get your c section approved? I am literally in the EXACT same scenario, have had persistent GH for the last 17 years and it's the worst thing that ever happened to me in my life. It's been pretty much constantly present throughout my pregnancy and the anti virals aren't working. The symptoms don't always present In lesions but I know it's there, lurking. I am absolutely terrified of harming my baby. I've requested a c section but I am being faced with constant dismissal of my symptoms and ongoing persuasion to have a vaginal birth because the risks as are low. A potential 3% risk is not low enough in my eyes and I'm now at 37+4 without an approval for a section 😔

It is very likely that if you stick to your guns, the Consultant will immediately say yes. I had the same in the NHS 20 years ago....an hour of a Registrar's time wasted trying to talk me out of it, but consultant said yes fine, much safer for the baby!

@CMAYF11

Under NICE guidelines they CANNOT refuse. Here are the guidelines.

The National Institute for Health and Care Excellence (NICE) sets out national, evidence-based guidelines for NHS and other healthcare providers to improve standards in many areas of health and social care. NICE guidance on maternal requests for caesarean section says that:

a woman’s request for a caesarean section should be explored and discussed and the specific reasons for her request should be recorded;
if a woman requests a caesarean section when there is no medical indication for it, the risks and benefits of caesarean compared to vaginal birth must be discussed with her to explore her reasons and ensure that she has accurate information. If necessary, the discussion can involve other members of the obstetric team. The discussion should be recorded in her medical records.
if anxiety about childbirth is the reason for the request, she should be offered a referral to a professional with expertise in perinatal mental health support to help her deal with her anxiety;
if after discussion and the offer of support a vaginal birth is still not an acceptable option, she should be offered a planned caesarean section;
if her own obstetrician is unwilling to perform her caesarean section, she should be referred to another obstetrician who will carry out the caesarean.

As you have pointed out, these are GUIDELINES - not law. This is literally what the OP has said has happened so far. It has been discussed, her request has been passed onto another consultant and she has been told that if the consultant won’t perform a CS, she will be passed onto another consultant. A consultant in any field of medicine cannot be forced into performing a procedure that they may not believe is in their patients best interest, especially if they, in their professional opinion, believe the requested procedure to be more harmful than an alternative one.

OP, please try to remain calm. You have been referred into the consultant and it may well be that they accept you need to have a CS. You haven’t actually been refused one have you?

@Creado

Can I ask *@RollneckJumper* did you get your c section approved? I am literally in the EXACT same scenario, have had persistent GH for the last 17 years and it's the worst thing that ever happened to me in my life. It's been pretty much constantly present throughout my pregnancy and the anti virals aren't working. The symptoms don't always present In lesions but I know it's there, lurking. I am absolutely terrified of harming my baby. I've requested a c section but I am being faced with constant dismissal of my symptoms and ongoing persuasion to have a vaginal birth because the risks as are low. A potential 3% risk is not low enough in my eyes and I'm now at 37+4 without an approval for a section 😔

@Creado

Yes, I did get my ELCS. I had to meet with the consultant and explain why I wanted an ELCS. Again, we went over all the risks etc. I had done my homework, so I was well prepared. So sorry to hear you are fighting an uphill battle. I feel for you.

Stand firm and don't be talked out of your decision. Your concerns over the risk of GH are valid, don't let anyone try and minimise your worries to push you towards a birth plan you are not happy with.

On the day of my ELCS, I was told to arrive at the hospital at 8am, but at 4am I went into labour! I arrived at hospital at 5am. Thankfully it was latent early labour and my cervix hadn't started to open.
There I was, laying in the hospital bed, contractions coming and going.. when a doctor entered the bay. It was the doctor who had originally attempted to talk me out of my decision to have an ELCS. I was not happy to see her! Can you believe she chose that moment to again try and persuade me to have a vaginal birth!! I stood my ground. I said no. Told her that I was adamant I wanted a ELCS. My DC was delivered at 10.11am with no complications.

Good luck! Just keep pressing for what you want and don't let anyone sway you x

@RollneckJumper thanks so much for your reply. Likewise I've read all the reports and written a well informed letter to the consultant, praying this final plea works. So happy it all worked out for you and you got your baby here safe and sound x

I could have written this. I also have both. You're amazing that you have discussed this with your health team, that's so admirable.

Personally I was too ashamed (no blight on you at all, please don't think it is!) to tell anyone. I had two DS vaginally (sp?) and they're in their 20s now. All okay.

The birth of your DC, however they arrive, will fade. You'll be immersed in the wonder of them! Birth is a matter of hours, you will have a whole lifetime of joy when you hold them in your arms for the first time.

Oooh zombie thread! I didn't notice! OP I hope you and your LO are having the best of times!

They will allow you a c section, they just won't give you that definitive "yes" right now in the hope that you will change your mind, (saving them time and money). This is at the expense of your mental health! If you have a good midwife she should be able to explain this. I requeseted ecs at my local hospital in 2019. They discuss all the risks at each appointment then book you in at week 36, effectively leaving you unsure if its actually granted until then. Total headfuck. I actually cancelled the whole thing in the end as I chickened out but my circumstances were completely different to yours and for what it's worth I think you are choosing the only sensible option. You will get it if you stand your ground, it IS your body, your choice. You are refusing v. Birth, not them refusing ecs. Best wishes to you and baby xx

Rollneckjumper it wasn’t a well known London teaching hospital was it. It sounds similar to a family members experience in that we had the agreement to a c-section in writing because of health but she tried to not agree csection when Labour had started.

I honestly don’t believe the consultant will not agree!! Honestly, the consultants don’t personally mind whether you have a c section or a natural delivery. If is mentally in the best interests of the mother then
you will get one I’m sure

@Pumpertrumper

I’m really sorry you’re feeling this way OP anxiety is hideous

In the nicest way possible I think the NHS is just overwhelmed with women who chose to get pregnant, knowing the natural end to this is usually vaginal birth, but then are desperate for C-sections. Obviously under usual circumstances I would argue every woman should have the choice but given where the nhs is with covid and how many needed operations have been cancelled/postponed leaving people in awful pain/suffering I’m not sure it is unreasonable for them to be cutting right back on ‘optional’ procedures.

When I got pregnant I had a severe long standing, crippling fear of vomiting. I’d had therapy, CBT, you name it! I got HG. I took every medicine they gave me and nothing worked, some made it worse. For months I was depressed, miserable (also had perinatal team/psychologist help) but it kept happening. I had breakdowns, didn’t change anything.

I’m afraid to an extent if you enter pregnancy knowing you’re triggered by a common pregnancy issue (vaginal birth, vomiting...etc) you’re pretty much taking on the chance you’ll have to go through that fear.

I was also terrified to give birth because of a sexual trauma in my teens. So I do empathise deeply. I ended up giving birth with an epidural but I found the whole experience of pregnancy/birth deeply traumatic.

I’d remain hopeful that they will agree your c-section but I’d brace myself for the possibility it may be denied. Try and work with the perinatal team on coping strategies, breathing exercises, medication that might help relax you...etc

This. We’re not in normal circumstances thanks to covid so there’s so many instances where people don’t get the care/procedures that they need/want, but unfortunately it’s not going to get any better.

It’s up and down the country, in every field of the NHS so I wouldn’t bank on being able to change their mind. They probably haven’t got the staff.

When I had my two babies (youngest not even 10) they didn’t even offer epidurals at the hospital. It just wasn’t an option as there wasn’t enough anaesthetists was the reason I was told but most other hospitals offered them. They did have anaesthetists there but only for emergency cases. I assume it’s a similar situation now.

A postcode lottery unfortunately

They talk you through the risks to make sure you definitely want it, it can come across as they are talking you out of it.

I had a nurse come do the same when I had an epidural for my surgery for my tear, but it's mainly them explaining the risks. The doctor you saw may not have been able say yes or no to a c-section as that is down to the consultant.

When you speak to the consultant they will probably not even batter an eyelid at booking you in xx

You are correct, NICE are 'best practice' guidelines not law and unfortunately at the moment lots of trusts cannot offer c-sections without a medical reason, mostly due to capacity issues. My trust is the same and won't allow a C-section based on maternal preference alone which so shame for some many women. However it could be argued that your anxiety is actually a sufficient 'medical reason' to warrant a C-section so I would definitely keep pushing (either via your midwife/consultant or hospital PALS department) to get them to reconsider based on the impact this is having on you.

In the nicest way possible I think the NHS is just overwhelmed with women who chose to get pregnant, knowing the natural end to this is usually vaginal birth, but then are desperate for C-sections. Obviously under usual circumstances I would argue every woman should have the choice but given where the nhs is with covid and how many needed operations have been cancelled/postponed leaving people in awful pain/suffering I’m not sure it is unreasonable for them to be cutting right back on ‘optional’ procedures.

I don’t think you really do mean this in the nicest way possible, but remember that vaginal births often do require a huge amount of follow-up care. Put it this way, my vaginal birth required many more hours of follow-up care (which included many hours spent in an operating theatre) than most mums who have a caesarean - a caesarean would have been a considerably more cost and time effective option from the NHS’ point of view.

And I realise OP has had her baby now but she wasn’t just frightened, she was specifically worried about passing herpes to her baby. Which, if it had happened, would have required quite a lot of expensive care…